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En France, au début de l’année 2020, environ 690 000 vies ont pu être épargnées grâce au confinement général de la population et aux mesures restrictives de lutte contre la Covid-19. Conséquence inattendue, ces mesures ont eu un impact sur une autre frange vulnérable de la population : celle des jeunes enfants, pour lesquels il a été démontré une augmentation des maltraitances subies à cette période. À partir de données de la littérature et de l’apport de nos travaux de recherche dans le domaine, nous proposons une documentation de cette crise des violences intra-familiales, intriquée dans la crise sanitaire de la Covid-19.

Denial of pregnancy is a rare psychic process associated with an increased risk of infant death. Forensic examinations to determine viability at birth can heavily influence the legal proceedings in cases of clandestine deliveries that result in the death of the infant. A 32-year-old woman who experienced a denial of pregnancy up to 30 weeks of amenorrhea reported giving birth at home at an estimated term of 35 weeks of amenorrhea. No one witnessed the delivery. She claimed the infant was stillborn. Forensic examinations revealed characteristic features of a live born infant. The mother tested positive for mifepristone. Mifepristone is an anti-progestin drug used for early abortion and to induce labor in cases of in-utero fetal death in later pregnancy. Even if mifepristone crosses the placenta, it has no direct toxic effect on the fetus. Our observations suggest premature live birth caused by mifepristone, followed by asphyxia due to meconium inhalation syndrome associated with lung immaturity especially since the birth occurred at home and no medical care was provided after the birth. The tragic outcome of this clinical case calls for vigilance and global management, including the psychiatric care of parturients in the context of late discovery of pregnancy. In France, this situation showed a legal gap between the consideration of the fetus and laws concerning abortion. To our knowledge, in France, this case has allowed the court to set a legal precedent as a similar case had never been reported elsewhere.

International audience; Background: In France, the COVID-19 pandemic led to a general lockdown from mid-March to mid-May 2020, forcing families to remain confined. We hypothesized that children may have been victims of more physical abuse during the lockdown, involving an increase in the relative frequency of hospitalization. Methods: Using the national administrative database on all admissions to public and private hospitals (PMSI), we selected all children aged 0–5 years hospitalized and identified physically abused children based on ICD-10 codes. We included 844,227 children hospitalized in March–April 2017–2020, of whom 476 (0.056%) were admitted for physical abuse. Relative frequency of hospitalization for physical abuse observed in March to April 2020 were compared with those from the same months in the three previous years (2017–2019). Findings: Even if absolute number of children exposed to physical abuse did not fluctuate significantly, we found a significant increase in the relative frequency of young children hospitalized for physical abuse from 2017 (0.053%) to 2020 (0.073%). Compared with the 2017–2019 period, and considering the observed decrease in the number of overall hospital admissions during the first lockdown, the number of children exposed to physical violence was 40% superior to what would be expected. Interpretation: The sharp increase in the relative frequency of hospitalizations for physical abuse in children aged 0–5 years in France is alarming. As only the most severe cases were brought to the hospital for treatment during the lockdown, our figures probably only represent the tip of the iceberg of a general increase of violence against young children.

A 67-year-old man was found dead, at his home. On external examination, we found a voluminous purplish black ecchymosis of the anterior neck area. On internal examination, we found a voluminous epiglottis hematoma completely obstructing the upper airway. It was associated with other sites of intra-abdominal hemorrhage. Toxicological studies revealed the presence of warfarin at a concentration of 8.4 mg/L in peripheral blood, which supposes an INR well above 4.5. To conclude, we supposed death was due to asphyxia secondary to a spontaneous epiglottic hematoma caused by a high blood concentration of warfarin. Hemorrhage in the epiglottis is very rare. To our knowledge, our patient is the only case of “sudden death” reported with spontaneous epiglottic hematoma due to high blood concentration of warfarin. In forensic practice, an anterior neck ecchymosis, without trauma, may suggest hemorrhage into soft airway tissues. Pathology findings make it possible to exclude exogenous trauma.

Summary Objectives The number of detainees held in police custody in France increased up to 792,000 yearly in 2009. Medical examination is a right for every detainee. Our objective was to assess medical characteristics and addictive behaviours of arrestees. Methods In this study, we systematically evaluated arrestees detained in police custody in Seine-Saint-Denis, a suburban area near Paris over one year (June 1, 2010–May 31, 2011). Results A total of 22,379 medical examinations were performed. Males accounted for 94% of detainees. Median age was 23 (range: 13–78). In 2968 of 18,466 cases (16%), the detainee had at least one chronic somatic disease. Asthma, diabetes, and arterial hypertension were the most commonly encountered. A history of psychiatric disorder was reported in 819 of 16,697 cases (5%). Daily alcohol consumption was reported by 14% of detainees and 77% smoked tobacco. Drug use was reported by 40% of detainees, cannabis in most cases (38%), infrequently cocaine or crack (4%) or heroine (1%). Assaults were reported by 20% of detainees, at the time of arrest in most cases (11%). Perspectives The present study showed the high frequency of addictive behaviours and reported assaults or traumatic injuries in arrestees. Attending physicians should pay particular attention to addictive disorders and recent traumatic lesions in arrestees, both for immediate care and for prevention.

Introduction L’objectif de ce travail est de reperer les situations de maltraitances physiques a enfants et d’evaluer leurs consequences, en termes de mortalite, a partir des donnees du PMSI. Methodes Ont ete incluse, tous les enfants âges de 0 a 2 ans, hospitalises en France entre 2007 et 2014. A partir des codes CIM-10, generes pour le PMSI a chaque sejour hospitalier, trois groupes d’enfants ont ete definis : 1) ceux ayant un code dedie aux maltraitances physiques ; 2) ceux ayant un code de lesions suspectes de mauvais traitement, 3) les autres enfants hospitalises. Une estimation de la frequence nationale de ces maltraitances physiques a ete calculee, selon deux methodes, l’une conduisant a une probable sur-estimation et l’autre a une sous-estimation. Les groupes ont ete decrits puis compares sur leurs caracteristiques demographiques, les sejours hospitaliers (nombre, duree, motifs, saisonnalite) et le taux de mortalite hospitaliere. Resultats Cette etude comporte 2 628 386 enfants dont 4172 du groupe1 et 12 024 du groupe 2. Les deux estimations de la frequence nationale, en 2014, sont de 0,2 ‰ et 0,9 ‰. Dans le groupe1, 69 % des enfants ont moins de1 an contre 52 et 51 % dans les groupes 2 et 3. Lors du premier sejour, la duree moyenne etait respectivement de 10,8, 7,5 et 3,0 jours et le pourcentage de deces hospitalier de 2,6, 2,3 et 0,3 %. Les trois groupes sont significativement differents (p Discussion/conclusion Un enfant sur trois presentant des lesions suspectes de maltraitance (groupes 1 et 2) a ete diagnostique comme tel (groupe1). Ces enfants sont hospitalises plus jeunes, ont des durees de sejours trois fois plus longues et un taux de mortalite hospitaliere 10 fois plus important que les enfants sans lesions suspectes (groupe 3). Des travaux complementaires sont necessaires pour estimer avec precision la frequence des maltraitances physiques (

Accurate identification of factors associated with progression of colorectal cancer remains a challenge. In particular, it is unclear which statistical methods are most suitable to separate the effects of putative prognostic factors on cancer progression vs cancer-specific and other cause mortality. To address these challenges, we analyzed 10 year follow-up data for patients who underwent curative surgery for colorectal cancer in 1985–2000. Separate analyses were performed in two French cancer registries. Results of three multivariable models were compared: Cox model with recurrence as a time-dependent variable, and two multi-state models, which separated prognostic factor effects on recurrence vs death, with or without recurrence. Conventional multi-state model analyzed all-cause mortality while new relative survival multi-state model focused on cancer-specific mortality. Among the 2517 and 2677 patients in the two registries, about 50% died without a recurrence, and 28% had a recurrence, of whom almost 90% died. In both multi-state models men had significantly increased risk of cancer recurrence in both registries (HR = 0.79; 95% CI: 0.68–0.92 and HR = 0.83; 95% CI: 0.71–0.96). However, the two multi-state models identified different prognostic factors for mortality without recurrence. In contrast to the conventional model, in the relative survival analyses gender had no independent association with cancer-specific mortality whereas patients diagnosed with stage III cancer had significantly higher risks in both registries (HR = 1.67; 95% CI: 1.27–2.22 and HR = 2.38; 95% CI: 1.29–3.27). In conclusion, relative survival multi-state model revealed that different factors may be associated with cancer recurrence vs cancer-specific mortality either after or without a recurrence.

The number of detainees held in police custody in France increased up to 792,000 yearly in 2009. Medical examination is a right for every detainee. Our objective was to assess medical characteristics and addictive behaviours of arrestees.In this study, we systematically evaluated arrestees detained in police custody in Seine-Saint-Denis, a suburban area near Paris over one year (June 1, 2010-May 31, 2011).A total of 22,379 medical examinations were performed. Males accounted for 94% of detainees. Median age was 23 (range: 13-78). In 2968 of 18,466 cases (16%), the detainee had at least one chronic somatic disease. Asthma, diabetes, and arterial hypertension were the most commonly encountered. A history of psychiatric disorder was reported in 819 of 16,697 cases (5%). Daily alcohol consumption was reported by 14% of detainees and 77% smoked tobacco. Drug use was reported by 40% of detainees, cannabis in most cases (38%), infrequently cocaine or crack (4%) or heroine (1%). Assaults were reported by 20% of detainees, at the time of arrest in most cases (11%).The present study showed the high frequency of addictive behaviours and reported assaults or traumatic injuries in arrestees. Attending physicians should pay particular attention to addictive disorders and recent traumatic lesions in arrestees, both for immediate care and for prevention.